Long‐term experience with simultaneous kidney–pancreas transplantation with portal‐enteric drainage and tacrolimus/mycophenolate mofetil‐based immunosuppression

Stratta, Robert J.; Shokouh-Amiri, M H; Egidi, Maria Francesca; Grewal, Hani P.; Lo, Agnes; Kizilisik, A.T; Nezakatgoo, Nosratollah; Gaber, Lillian W.; Gaber, A. Osama

doi:10.1034/j.1399-0012.17.s9.13.x

Cited by 26 publications

(19 citation statements)

References 40 publications

(72 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its overall use to suppress T cells is similar to that of azathioprine and cyclosporin, although the mechanisms of effect are different (see Table I) [20][21][22][23][24]. MMF is a prodrug of mycophenolic acid (MFA), a non-competitive inhibitor of inosine 5 0 -monophosphate dehydrogenase (IMPDH), which is a key enzyme involved in the purine biosynthesis pathway [20].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of mycophenolate mofetil as single‐agent therapy for refractory immune thrombocytopenic purpura

et al. 2005

View full text Add to dashboard Cite

Refractory disease occurs in 25% or more of adults with idiopathic (immune) thrombocytopenic purpura (ITP). Therapy to elevate the platelet count may be required in a proportion of these patients. Immunosuppressive agents such as prednisone, azathioprine, cyclophosphamide, and cyclosporin have been shown to be effective treatments in a proportion of patients with refractory ITP. A newer immunosuppressive medication, mycophenolate mofetil (MMF), has been used successfully with acceptable toxicity in solid organ transplant patients to reduce the risk of organ rejection. The goal of this study was to determine whether MMF is an effective treatment for refractory ITP. Efficacy, defined as a sustained platelet increase to a level greater than 50 × 109/L, was seen in 7 of 18 patients with refractory ITP. Three of these 7 patients have had intermittent thrombocytopenic episodes while continuing the medication. No severe toxicity was seen, although two of the 18 patients discontinued MMF within the first month of treatment because of side effects, i.e., headache. In summary, MMF may be a useful component of a combination protocol but does not appear to be highly effective as sole therapy in patients with refractory ITP. The data suggests that response rates to MMF may be higher in patients who have had a shorter duration of their ITP. Am. J. Hematol. 81:19–25, 2006. © 2005 Wiley‐Liss, Inc.

show abstract

Section: Introductionmentioning

confidence: 99%

Efficacy of mycophenolate mofetil as single‐agent therapy for refractory immune thrombocytopenic purpura

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Except a recommendation A for immunosuppression, the level of evidence for these recommendations and statements is limited to B or C. Despite a few large series with very convincing data (17,24,25,31,32,51), the total number of patients analyzed remains relatively low. We conclude, however, that based on this best available scientific evidence, SPK is currently the gold standard to which other therapies should be compared.…”

Section: Discussionmentioning

confidence: 99%

An Evidence‐Based Analysis of Simultaneous Pancreas‐Kidney and Pancreas Transplantation Alone

Demartines

Schiesser

Clavien

2005

American Journal of Transplantation

View full text Add to dashboard Cite

While pancreas transplantation has evolved within two decades from a frustrating and poorly-accepted therapeutic option to a highly successful procedure, the respective benefits of the successive surgical and immunosuppressive developments have remained unclear. The aim of this study was to determine using an evidence-based methodology, which novel approaches have contributed to the current results and whether pancreas transplantation is cost-effective. Out of 2481 articles, 102 analyzed either surgical or immunosuppressive aspects of pancreas transplantation. Urological complications were more frequent in bladder over enteric drainage (range: 62-63% vs. 12-20%, p = 0.0001), but without significant difference in patient or graft survival. Portal drainage was associated with a trend toward fewer complications and better hyperinsulinemia control over systemic drainage in retrospective studies. Immunosuppression combining induction therapy, a calcineurin inhibitor, mycophenolate mophetil (MMF) and corticosteroids were associated with a 40% decreased incidence of rejection (p = 0.01) and an increase in graft survival above 90% at 1 year (p < 0.05). Pancreas transplantation is highly cost-effective compared to conservative alternatives. We conclude that despite a paucity of large studies, enteric drainage should be recommended but the benefits of portal venous drainage remain debated. Quadruple immunosuppression protocols including induction therapy should be the standard regimen.

show abstract

“…Overall, the predisposition to a venous thrombosis and difficulty in managing it has been reported as the most common nonimmunologic cause for pancreatic graft loss. 1,5,6 Infarction of a pancreatic transplant has major systemic consequences, making emergency graft pancreatectomy, itself, an operation with significant risk of morbidity and mortality. The clinician and patient are then left with the choice between the technically challenging option of pancreatic retransplant or the potentially unacceptable medium and long-term risk of cardiovascular disease, disablement, and death.…”

Section: Discussionmentioning

confidence: 99%

“…4 Thrombosis of the pancreatic graft's portal vein is a potentially devastating complication, being notoriously hard to treat and commonly leading to graft failure. 1,5,6 Attempts at surgical thrombectomy are often unsuccessful, 7,8 and so, medical treatment with systemic anticoagulation is sometimes recommended, especially for partial thrombosis of the pancreatic portal vein. 9,10 We describe a case of a pancreatic transplant venous thrombosis that was diagnosed early and successfully and salvaged by using interventional radiologic techniques.…”

Section: Introductionmentioning

confidence: 99%

Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review

Asher

Talbot²,

Manas³

et al. 2013

Exp Clin Transplant

View full text Add to dashboard Cite

Simultaneous kidney and pancreatic transplant is the criterion standard for treatment of end-stage renal failure because of diabetic nephropathy. Venous thrombosis occurs in approximately 5% of pancreatic transplants, and it is notoriously difficult to treat, forming the most common nonimmunologic cause of graft loss. We report a case of early detection of pancreatic graft venous thrombosis by measuring urinary amylase, resulting in the successful endovascular salvage of the pancreatic graft.

show abstract

Long‐term experience with simultaneous kidney–pancreas transplantation with portal‐enteric drainage and tacrolimus/mycophenolate mofetil‐based immunosuppression

Abstract: These findings suggest that SKPT with P-E drainage and contemporary immunosuppression may result in excellent intermediate-term outcomes.

Cited by 26 publications

References 40 publications

Efficacy of mycophenolate mofetil as single‐agent therapy for refractory immune thrombocytopenic purpura

Efficacy of mycophenolate mofetil as single‐agent therapy for refractory immune thrombocytopenic purpura

An Evidence‐Based Analysis of Simultaneous Pancreas‐Kidney and Pancreas Transplantation Alone

Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review

Contact Info

Product

Resources

About